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Randomized Controlled Trial
. 2020 Oct 1;21(10):2529-2537.
doi: 10.1093/pm/pnaa150.

Changes in Perceived Stress After Yoga, Physical Therapy, and Education Interventions for Chronic Low Back Pain: A Secondary Analysis of a Randomized Controlled Trial

Jonathan Berlowitz  1 , Daniel L Hall  2   3 , Christopher Joyce  4   5 , Lisa Fredman  6 , Karen J Sherman  7   8 , Robert B Saper  1 , Eric J Roseen  1   4
Affiliations
Randomized Controlled Trial

Changes in Perceived Stress After Yoga, Physical Therapy, and Education Interventions for Chronic Low Back Pain: A Secondary Analysis of a Randomized Controlled Trial

Jonathan Berlowitz et al. Pain Med. .

Abstract

Objective: Perceived stress and musculoskeletal pain are common, especially in low-income populations. Studies evaluating treatments to reduce stress in patients with chronic pain are lacking. We aimed to quantify the effect of two evidence-based interventions for chronic low back pain (cLBP), yoga and physical therapy (PT), on perceived stress in adults with cLBP.

Methods: We used data from an assessor-blinded, parallel-group randomized controlled trial, which recruited predominantly low-income and racially diverse adults with cLBP. Participants (N = 320) were randomly assigned to 12 weeks of yoga, PT, or back pain education. We compared changes in the 10-item Perceived Stress Scale (PSS-10) from baseline to 12- and 52-week follow-up among yoga and PT participants with those receiving education. Subanalyses were conducted for participants with elevated pre-intervention perceived stress (PSS-10 score ≥17). We conducted sensitivity analyses using various imputation methods to account for potential biases in our estimates due to missing data.

Results: Among 248 participants (mean age = 46.4 years, 80% nonwhite) completing all three surveys, yoga and PT showed greater reductions in PSS-10 scores compared with education at 12 weeks (mean between-group difference = -2.6, 95% confidence interval [CI] = -4.5 to -0.66, and mean between-group difference = -2.4, 95% CI = -4.4 to -0.48, respectively). This effect was stronger among participants with elevated pre-intervention perceived stress. Between-group effects had attenuated by 52 weeks. Results were similar in sensitivity analyses.

Conclusions: Yoga and PT were more effective than back pain education for reducing perceived stress among low-income adults with cLBP.

Trial registration: ClinicalTrials.gov NCT01343927.

Keywords: Chronic Low Back Pain; Physical Therapy; Stress; Underserved Populations; Yoga.

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Figures

Figure 1.
Figure 1.
Study flow diagram.
Figure 2.
Figure 2.
Changes in perceived stress scale scores for 248 participants with complete data at baseline, 12 weeks, and 52 weeks.
See this image and copyright information in PMC

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